Digestive Health Part 13: SIBO

Written by Dr. Claire Arcidiacono, ND SIBO

For further questions or concerns email me at [email protected]†

Our very last topic is small intestinal bacterial overgrowth or SIBO for short. SIBO is an imbalance of bacteria in the small intestine where one type of bacteria in the intestines takes over. Normally, the bacteria in the small intestine is balanced, with no one type being dominant. This balance is maintained by the presence of many types of  “good” bacteria, gastric or stomach acid, bile, enzymes, and immunoglobulins.  For different reasons, these control mechanisms can fail and the bacteria balance tips in favor of 1 type of bacteria who then proceed to overgrow. (1)

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What are the signs of SIBO? Normally there is diarrhea and occasionally constipation. However, in my clinical experience, constipation happens more than you would expect. There is often gas, bloating, nausea with occasional vomiting, uncomfortable feeling of fullness or even outright abdominal pain. Loss of appetite often leads to weight loss as well as malnutrition. Systemic symptoms of SIBO include brain fog, fatigue, joint pain, insomnia, and is even associated with low B12. (2)

SIBO is normally determined by a breath test. The bacteria breakdown lactulose; when you breathe out you expel the hydrogen (H2), methane (H4) or Hydrogen sulfide (H2s) produced by the bacteria. The H2 predominant form of SlBO is associated more closely with diarrhea while the H4 predominant form of SIBO is more closely related to constipation. (3)

What are the risk factors for SIBO?  Anything that prevents food from moving through the small intestines properly. As the food stays in the small intestine, the bacteria grow faster than expected. Things that can cause the food to move too slowly through the small intestine include low stomach/gastric acid, any physical changes in the intestines including those that are congenital, as well as stress and anxiety. Other risk factors include surgical procedures such as gastric bypass, and surgery/radiation treatments. Any injury to the small intestine including anal fistulas and blockages in the GI tract are also risk factors for SIBO. IBD both Crohn’s and Ulcerative colitis are also risk factors. There are also systemic medical concerns that can increase the risk of SIBO. These include HIV, immunoglobulin A deficiency as well as diabetes and lupus. Medications such as antibiotics, PPIs, certain medications for IBS as well as narcotics all increase the risk of SIBO. (4)

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Treatment for SIBO is much more complex than just taking a probiotic to help restore balance to the digestive tract. The reason is that SIBO is an overgrowth of bacteria. In my clinical experience, it appears to usually be bad or pathogenic bacteria. However, in some individuals, it appears that the overgrowth is caused by what is normally considered “good” bacteria. Therefore it is hypothetically possible a bacteria based probiotic could make the situation worse. Therefore, changing the “terrain” to reduce the risk of bacteria overgrowth is important in working with SIBO. Interestingly, yeast based probiotics do not have this concern. (5) Since SIBO is an overgrowth of bacteria, antibiotics are used to kill the bacteria. The next conventional recommendation is to follow a low fodmap diet. Eliminating any foods that increase symptoms is also important. Lastly if there are any underlying concerns such as diabetes, lupus, crohn’s or diverticulosis for example those need to be addressed first. (2).

In order to work with SIBO there is a more systematic approach that is helpful:

• We must regulate the overgrowth of bacteria
• We must increase the immune system as well as normalize the transit of food through the small intestine to avoid bacterial overgrowth
• We must heal the damage caused by SIBO
• Once a negative test is achieved and we know that the terrain is healthy, we must repopulate the small intestine with a good quality probiotic. (3)

Supplement Suggestions: SIBO

• Garlic has been found in studies to help eliminate bacteria as well as fungus such as Candida. (6) See Invite’s Nutristatin 144 as well as our Aged Garlic!
• Olive leaf extract has also been found to help eliminate microbes such as yeast in the body. (7). See Invite’s Olive leaf extract as well as our Renalaid formula!
• Studies show that Saccharomyces can help with the symptoms of SIBO. (8) See Sacro-B a fabulous product offered by Invite!
• Colostrum is amazing when it comes to fighting off pathogens in the digestive tract. Colostrum helps to kill pathogens directly, boost the immune system and builds up the mucus layer which is part of what protects the digestive system from being damaged. (9) Please see Invite’s Colostrum, and our powered colostrum called Neuroimmune!
• Nucleotides, while not usually a supplement associated with the gut, has been found in studies to be helpful in working with boosting the immune system as well as promoting healing (10) Please see Invites Nucleotide complex!
• Demulcent herbs have been found to be helpful in lowering inflammation and any damage done in the digestive tract as well as reducing the incidence of opportunistic infection. This is important in working with SIBO because the bacteria often cause irritation in the digestive tract and can even lead to leaky gut. These demulcent herbs can include the following: DGL, Aloe Vera, Slippery Elm and Marshmallow root. (11) Please see Invite’s G.I Maintain Maintain, Min Acid and DGL.
• In the case of low stomach acid, there has been found to be a correlating low level of zinc as well as B vitamins. Correcting these deficiencies will eliminate the underlying cause of the slow transit time through the small intestine, one of the causes of SIBO (12) . Please see Invite’s Zinc products as well as our line of B vitamins!
• Digestive enzymes can help to break down the food and help to replace the acid missing due to low stomach acid. Once again, this helps with the low transit time that is a risk factor for SIBO (13) Please see Invite’s Digestive Hx and Prozyme digest.
• It is important to address any diarrhea or constipation as well as stress.

We have officially completed the digestive series! There will be a summary and then we’ll moving on to our next topic.

Sources

1. Johns Hopkins Medicine: “Small Intestinal Bacterial Overgrowth (SIBO).”
2. https://www.webmd.com/digestive-disorders/sibo-overview-what-is-it#091e9c5e81c61a6a-1-1
3. https://oc-integrative-medicine.com/do-you-have-sibo/
4. Cleveland Clinic: “Small Bowel Bacterial Overgrowth.”
5. https://health.usnews.com/health-news/blogs/eat-run/articles/2018-06-21/4-facts-about-sibo-the-internet-keeps-getting-wrong
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458355/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5490280/#:~:text=The%20present%20stud
8. https://www.optibacprobiotics.com/professionals/latest-research/gut-health/sibo-probiotics
9. https://www.nature.com/articles/s41598-019-39644-x
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3146642/
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6065514/
12. https://www.clinicaleducation.org/resources/reviews/the-role-of-hcl-in-gastric-function-and-health/
13. https://www.hopkinsmedicine.org/health/wellness-and-prevention/digestive-enzymes-and-digestive-enzyme-supplements

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